Acute kidney injury is a common and significant complication following ileostomy formation. (7th October 2021)

• Record Type: Journal Article
• Authors: Loria, Anthony; Melucci, Alexa; Speranza, Jenny; Cellini, Christina; Salloum, Rabih; Temple, Larissa K.; Fleming, Fergal J.; Justiniano, Carla F.
• Is Part Of: Colorectal disease. Volume 24:Number 1(2022)
• Page Start: 102
• Page End: 110
• Publication Date: 2021-10-07
• Subjects: AKI -- dehydration -- ERAS -- ileostomy -- ostomy output; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15917
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: The aim was to characterize the incidence and short‐term prognostic value of an acute kidney injury (AKI) during the admission where an ileostomy is formed. Methods: Adults with a baseline serum creatinine measurement discharged alive after ileostomy formation from 2014 to 2016 were included. All patients had daily basic metabolic panels and the Kidney Diseases Improving Global Outcomes criteria were used to determine the presence and severity of any AKI. Dehydration was defined by a single urine abnormality or clinical criteria combined with an objective abnormality in vitals or basic metabolic panels. Results: Of 262 patients, 19.4% sustained an AKI (74.5% Stage I, 15.7% Stage II, 9.8% Stage III) during the index admission. Predictors of incident AKI were increasing age, male sex, higher baseline creatinine and open surgery. Patients with AKI had significantly longer length of stay and 45% had creatinine <1.0 mg/dl at discharge. Of the total cohort, 11% were readmitted with dehydration and the independent predictors were AKI during the index admission, high ileostomy output, age >65 years, male sex and prior ileostomy. Of those readmitted with dehydration, 79% had AKI at readmission. Conclusions: Nearly 20% of patients with ileostomies develop an AKI during the index admission with almost half resolving by discharge. Patients with AKIs are at high risk for 30‐day dehydration‐related readmission and AKI is present in nearly 80% of those readmitted with dehydration. Since AKI is objective, based on routine laboratory measures, and has known prognostic value it is probably a more robust outcome than dehydration for researchers, surgeons and patients.